Bifurcated Stent Technique: A Viable Option for Treatment of Patients With Unusual Anatomy Presenting With Combined Chronic Mesenteric Ischemia and Diffuse Ischemic Gastric Ulcers

Treatment of chronic mesenteric ischemia has evolved over the last two decades. Endovascular therapy is now the treatment of choice for patients with lesions amenable to such an approach. Open revascularization remains the standard of care but is frequently being reserved for lesions containing intraluminal thrombus or severe calcification. In most cases, celiac axis (CA) stenting is not needed since revascularization of the superior mesenteric artery (SMA) alone results in symptomatic resolution. This report describes a case of a patient with chronic mesenteric ischemia and diffuse gastric ulcers found to have a common origin of the SMA and CA that was treated endovascularly using a bifurcated stent technique.

Successful endovascular treatment of severe chronic mesenteric ischemia by concurrent triple-vessel mesenteric artery revascularization

A 52-year-old man presenting with severely symptomatic chronic mesenteric ischemia had proximal occlusion of the celiac and superior mesenteric arteries and critical stenosis of the inferior mesenteric artery ostium. Concurrent percutaneous revascularization with stenting of all three mesenteric arteries was successfully achieved using techniques tailored to each lesion. Complete clinical recovery was observed at the six-month post-procedure follow-up.

Endovascular recanalization of the superior mesenteric artery in the context of mesenteric bypass graft infection

Mesenteric prosthetic graft infection is a rare and challenging clinical scenario. A patient is described who developed recurrent abdominal pain after occlusion of an iliomesenteric prosthetic bypass. Endovascular recanalization of the native superior mesenteric artery, which had been occluded for more than 10 years, was accomplished using axillofemoral through-wire access and a steerable guiding catheter. The infected prosthetic was then explanted and his graft-enteric fistula repaired. Technical and strategic considerations are discussed.